Staged whole lung lavage in severe pulmonary alveolar proteinosis-Anaesthetic strategies for one-lung ventilation: A case report.

Pulmonary alveolar proteinosis causes severe hypoxaemia. Whole lung lavage is standard therapy, but anaesthetic management of staged sequential bilateral lavage in patients with partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) <150 is challenging. We describe a 51-year-old female with autoimmune pulmonary alveolar proteinosis and respiratory failure who underwent staged lavage 3 days apart under general anaesthesia. A 35-Fr left-sided double-lumen tube (DLT) was placed with fibreoptic confirmation. Lung-protective one-lung ventilation was used with a tidal volume of 300 mL, a respiratory rate of 18/min, a positive end expiratory pressure of 6-8 cmH2O and FiO2 1.0. 10 L saline was used in right lung lavage with 9.2 L recovered over 185 minutes. Post-lavage PaO2 improved from 68 to 142 mmHg. 8 L saline was utilised in left lung lavage, with 7.5 L recovered over 160 minutes. Post-lavage PaO2 was 198 mmHg. The patient was extubated on the table after both procedures and discharged on room air on day 7. Sequential lavage with meticulous DLT positioning, lung-protective ventilation, serial arterial blood gas monitoring, and multidisciplinary coordination enabled safe management.